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Identity
Full name
Gender
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Male
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Other
Unknown
Date of birth
Leave blank and fill age if the DOB is unknown.
Age (years)
Given name
Family name
Contact & ABHA
Mobile number
Email
ABHA number
Exported as Patient.identifier with type ABHA.
ABHA address
Demographics
Marital status
Not recorded
Married
Never Married
Widowed
Divorced
unmarried
Blood group
Not recorded
A+
A-
B+
B-
AB+
AB-
O+
O-
Address
Address line
City / town
District
State
PIN code
Emergency contact
Contact name
Relationship
Contact phone
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